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Biomedical subjects

J Gómez-Arnau

Publications and source records attributed to J Gómez-Arnau.

At least 19 recordsLinked to original sources
PubMed2001

[General principles for the clinical organization and management of a surgical unit].

Because health-care costs and demand for services are both rising, appropriate management of resources is yet another essential consideration in efficient clinical practice. Surgical units, with their special features, are a particular focus of attention. Although it is possible to study the circumstances of each hospital individually, in fact surgical units often share the same management concerns. Currently, surgical units are often reorganized and provided with an Operating Room Committee, a Medical director or coordinator and operational protocols, such that the unit is considered a system rather than a sum of its individual parts. Work is goal-oriented, with starting and ending points, flexibility in use of surgical theaters, reserve capacity for unscheduled surgery, low cancellation rates and good output; the use of time indicators is considered essential. Other factors to bear in mind when managing a surgical unit are the universalization of information, which should be accurate and up to date, the involvement of teams such as that of anesthesia and recovery, scheduling that is realistic and tight, the appropriate design and use of circuits, and the use of techniques for continuous improvement and problem solving. Some programs, such as that of major outpatient surgery, orthopedic surgery and others may have special needs.

Operating Rooms↗
PubMed1999

Ruptured hemidiaphragm after bilateral lung transplantation.

A case of right hemidiaphragm rupture and abdominal herniation into the thorax occurring during the immediate post-operative course of double-lung transplantation is reported. This complication has not been reported previously. We examine the possible aetiology and suggest that the direct cause could be an increase in intra-abdominal pressure during chest physiotherapy.

Abdomen↗
PubMed1999

[Hospital organization of cardiopulmonary resuscitation].

That hospital cardiopulmonary resuscitation (CPR) should be supported by an organized plan rather than on the skills of individual health care personnel is a universally agreed-upon principle. Such a plan should guarantee that needed materials are available and in working order in all departments and that the team assigned to carry out CPR arrives promptly. Personnel other than the specialized team should also receive CPR training appropriate to their posts. The main features of a CPR plan are related to the five steps in the chain of survival: a) identification of a patient to be resuscitated, a matter that has important ethical ramifications; b) early recognition of cardiac arrest; c) early defibrillation; d) basic CPR, and e) advanced CPR. The CPR plan should incorporate the automatic recording of system, population, event and outcome variables. Task forces responsible for establishing and maintaining the plan and its quality control will periodically review the data with the aim of detecting errors, correcting them or introducing improvements. Various international societies and CPR committees have recently suggested a uniform way (the Utstein style) of recording and presenting data to allow comparisons either from hospital to hospital or over time within a single center.

Cardiopulmonary Resuscitation↗
PubMed1998

Selective impairment of endothelium-mediated vasodilation in liver transplant recipients with cyclosporin A-induced hypertension.

Arterial hypertension is commonly observed in orthotopic liver transplantation (OLT) recipients receiving cyclosporin A (CsA), but the precise pathogenetic mechanisms remain partially unknown. The aim of this study was to investigate endothelium-dependent and -independent dilation and adrenergic constriction of resistance vessels of OLT recipients treated with CsA. Vascular reactivity was examined in 22 OLT patients, 10 with and 12 without arterial hypertension, and in 10 control subjects by assessing the forearm blood flow response to the brachial artery infusion of increasing concentrations of methacholine chloride, sodium nitroprusside, and phenylephrine. In 10 OLT patients, the response to methacholine was also examined after acetylsalicylate. The ratio of serum nitrite and nitrate to serum creatinine was lower (P < .05) in OLT patients with hypertension than in nonhypertensive patients and controls. Basal forearm flow was similar in the three groups. Methacholine vasodilation was impaired in the hypertensive patients as shown by a lower maximum forearm vasodilator response and a shift in the dose response curve to methacholine to the right compared with the nonhypertensive OLT patients and the controls. The response to methacholine was not modified after salicylate. Forearm flow response to nitroprusside was similar in the three groups. No differences between the patients and the controls were found in the maximum forearm flow contraction in response to phenylephrine. An impairment in endothelium-dependent vasodilation could mediate arterial hypertension in OLT patients immunosuppressed with CsA.

Adult↗
PubMed1998

Hemostasis and blood requirements in orthotopic liver transplantation with and without high-dose aprotinin.

BACKGROUND AND OBJECTIVE: Several factors seem to lead to considerable bleeding and transfusion requirements during orthotopic liver transplantation (OLT) and postoperatively, but hyperfibrinolysis appears to be the most important factor. Aprotinin, a broad-spectrum serine protease inhibitor, has been shown to inhibit hyperfibrinolytic states. DESIGN AND METHODS: A non-randomized, controlled clinical trial was performed to assess the efficacy of aprotinin in 20 consecutive OLT procedures (group A). The results obtained were compared with the findings in two groups of patients who did not receive aprotinin: one control group (C1) consisting of the 20 consecutive recipients who underwent OLT immediately prior to group A, and a second control group (C2) consisting of the 30 consecutive recipients undergoing OLT immediately after group A. Twenty-three hemostatic parameters were studied in group A and C1 and the blood product requirements were compared in all three group. RESULTS: We observed a markedly reduced fibrinolysis in group A during the non-hepatic and reperfusion phases demonstrated by reduced tissue-type plasminogen activator (t-PA), alpha 2 antiplasmin-plasmin complex (APP) and D dimer levels and an increase in antiplasmin activity compared to C1 group (p < 0.05). In vitro experiments showed aprotinin to have an antiplasmin effect. The intraoperative transfusion of units of RBC and fresh frozen plasma (FFP) was significantly diminished in group A (8.1 and 16.7 U, respectively) when compared with groups C1 (20.4 and 36.0 U) and C2 (13.0 and 28.0 U) (p < 0.05); there was also a significantly greater number of patients not requiring intraoperative platelet transfusion in group A (p < 0.05). During the first 5 postoperative days, the number of patients in group A who did not require RBC transfusion was significantly larger than in groups C1 and C2 (p = 0.04). INTERPRETATION AND CONCLUSIONS: In this study, the inhibition of fibrinolysis associated with the prophylaxis with aprotinin, administered in high doses by continuous intravenous infusion, appears to reduce the need for blood product transfusion during the OLT procedure.

Adolescent↗
PubMed1997

[Postoperative cognitive dysfunction].

Although postoperative behavioral anomalies were first reported more than one hundred years ago, only in the past ten years has the profile for postoperative cognitive dysfunction (POCD) been defined. POCD is reversible and it has been suggested that the disorder has implications for increased mortality and morbidity if it is not diagnosed and treated early. At present the clinical presentation of POCD is thought to be variable and fluctuating, ranging from slight disorientation to coma. POCD can develop soon after surgery or appear several days later and its incidence is unknown as a result of the methodological difficulties involved in studying this entity. Of the various etiological factors that have been named, many can be modified during the period surrounding surgery. Once symptoms have developed,whether in the recovery unit or later, it is important to eliminate organic factors and begin treating the cause. The most important drugs for treatment are neuroleptics and benzodiazepines. We review the definition, epidemiology, etiology, pathophysiology and treatment of POCD and include a list of diseases and drugs associated with its development, as well as a description of psychological tests used for diagnosis.

Cognition Disorders↗
PubMed1995

[Special anesthesia care in heart transplantation. The management of right ventricular failure].

Right ventricular dysfunction is a common clinical event after heart transplantation. The major cause is the failure of right ventricle (RV) to adapt to the pulmonary hypertension (PH) secondary to chronic heart failure. Nevertheless, this dysfunction is usually transient owing to the reversibility of PH, the nature of which is mainly passive. Therefore, it is particularly important to perform a preoperative hemodynamic study to identify those cases in which PH is a permanent component, a situation that excessively increases the risk of postoperative RV failure. Once this occurs, the treatment is complex. The available therapeutic measures include the use of vasodilators such as prostaglandin E1 and nitric oxide.

Anesthesia↗
PubMed1982

Induced hypotension and Wolff-Parkinson-White syndrome.

A case is presented of a female patient with Wolff-Parkinson-White Syndrome in whom controlled arterial hypotension was required for the clipping of a posterior communicating artery aneurysm. The anaesthetic management is described, and the authors discuss the use of diverse drugs, based on the data provided by the electrophysiological study.

Adult↗